Thursday, February 22, 2007

Standardized patient seeks captive audience

Since leaving the world of full-time work to stay at home with my now nine-month-old baby, I have been scrounging for part-time gigs that bring in a few extra schekels and get me out of the house. Wanting more money didn't come as much of a surprise, but recently I've also learned that at-home parents crave daylight just as much as any angst-ridden Scandinavian teen in winter. I have never fancied myself a Jack of all trades but something tells me that by the time this kid hits kindergarten, I'll have tried my hand at everything short of selling my own body.

Well, ok, I actually tried that but I didn't have any buyers.

A fellow theater nerd aquaintance emailed me about a local medical school in need of make-believe patients, that is they wanted people to act the part of a convalescent. The hours were minimal but the pay made it worth looking into. Fifteen dollars per hour isn't a lot per se, but considering all I'd have to do is dress down to my underwear and pretend to have some illness while a wannabe doctor asked me some questions, I'd say it's worth my time. DId I mention this place is less than ten minutes from my house? Sweet.

Well, there was one minor drawback. The job would require me wearing draws, something I'm not normally fond of, but since these were the only people I found willing to pay me to get undressed, I thought I'd better take them up on the offer. Besides, I actually do own a pair of boxer briefs that need every once in a while to leave the darkness of my sock drawer and bask in the moonlilght.

Get it?

Moonlight?

Anyway, after filling out a lengthy application, agreeing to an interview and submitting references (apparently they don't want just any old psychopath participating in the program) I showed up one morning to fill the position. I sat through a one-hour training session given by a retired physician who instructed me and five other Munchausen sufferers on the ins and outs of playing doctor. Twas a good time had by all.

Rules were minimal. While I was provided with a brief profile of my character, a 68-year-old man who was suffering from severe chest pains and numbness in his arm, I could otherwise do as I pleased. Much of the work was impromptu and the real doctor even encouraged us to "just make it up" as we went along if we had to. I took him at his word.

Unlike actual doctor visits where I have to travel from one physician to another, this time they came to me. I had my own exam room complete with sink, exam table, tongue depressors, rubber gloves, swabs, the whole nine yards. This place was much like any other exam room I had ever been in only it was maybe double the size and it had cameras and a microphone sticking out of the ceiling.

When I entered the room and shut the door behind me to change, I glanced up at the cameras and made a mental note. There was to be no nose picking, no ass scratching, no readjusting, no audible farting and no snooping in drawers. Also nothing that could be used as credible evidence in any future competency hearing. I changed into the hospital gown, shoved my clothes behind the exam table and waited for the first future doctor to arrive.

He knocked before entering and came in sporting a shirt and tie underneath his white labcoat. I don't normally see doctors in neckties but this guy looked all of fourteen years old, so he may have been advised to wear it with the hopes of adding years to his appearance. Did Doogie Howser wear a necktie? I didn't watch the show.

I do have an old man voice that I use when reading stories to children so I thought I'd adopt it here.I never had to get up off the table, so little movement was required on my part. I didn't need to figure out how an old man walks necessarily. I just moved slower than I normally would when motioning to where my pains were. The student asked questions; I answered. If I didn't readily have an answer, I made one up. When it was over, he left and I scored him on various criteria on a rubrick that went from one to nine.

Surprisingly enough, the first of these encounters proved to be pretty easy. It soon became evident that these sessions were much harder on the students than they were on me. All I had to do was pretend to be an old man with chest pains. The students had to assess, question and diagnose. Furthermore they knew that they were later going to have to watch themselves on screen along with everyone in their class.

After my first session the real doctor came in to tell me I needed to be more animated. He didn't want the old man just to have had chest pains a few days ago. He wanted him to be having chest pains throughout the exam. In other words I was supposed to be faking a heart attack. I can do that, I though.

My thespian self emerged and once I let go of being Kevin, I channeled a 68-year-old man complete with name, heart condition and backstory. Some details had already been provided to me like a recent cholesterol reading, when the onset started and so forth, but I still had plenty of room for creativity. I didn't launch into a diatribe about being born a poor black child in Mississippi or anything, but I think I came up with some good stuff.

I was a retired bus driver who was married with two grown children, both in good health. My wife, also retired, had successfully nagged me into finally going to see the doctor about my aches and pains, the most recent of which started just ten minutes ago when I was coming up the stairs to my appointment. My mother had had heart disease and died in her early forties. The scar on Kevin's arm from where he had a keloid removed evolved into a bullet wound. I told one student my father was still living, while I told another he died in a tragic accident. I even have a twin brother who carries nitroglycerin with him.

My performance got better as I went along even if I do say so myself. Near the end of the day (I did this for five hours) I was asked to change my routine up a little bit. Students had begun to share with each other what they thought the proctors were looking for, so the goal now was to throw them a curve ball.

"I want you to die," the doctor said.

"Die as in dead die?" I asked.

He confirmed he wanted me to actually fall out and croak. Having never seen someone die before I asked the good doctor for a few pointers. Did I have to die with my eyes open? Would I die clutching my chest? He provided the visuals for what I thought was a mediocre rendition of dying of a heart attack, but it gave me an idea.

When the next student came in and introduced himself I shook his hand and began grunting. He got through a few questions but then saw I needed immediate attention. This was actually comforting to see because a few of the previous students kept wanting to ask me questions about my family's medical history and one insisted on looking into a dying man's ears and nose. This student however quickly stepped out of the room and said to a make-believe nurse, "We need an ambulance. Somebody call 9-1-1." Looking back, I wish I had thought to shout This is the big one! I'm comin' to see you, Elizabeth, but I didn't. I just cleched my chest one last time, grunted and fell back on the table.

The student took one look at me and said, "And it looks like you're dead." For the sake of the microphone he went on to say he'd be performing CPR at that point. I was glad he didn't put his mouth to mine. I had already been informed that after I died I was to wait a few seconds, then rise from the dead and tell the student he could leave the room.

When that Oscar performance was over, the real doctor came in and said he wanted to see it again. He was starting to sound more like a director at this point, telling me he wanted it o happen even sooner.

"As soon as he shakes your hand, keel over and die."

"You mean first thing?" I asked.

"First thing. You can even fall off the table if you want to." With that the doctor left the room

Let me just say dying takes a lof out of a person. I guess to die with dignity as someone kicks the plug out can be a quiet affair, but who wants to see that? This was my first day on the job and I needed to show the boss what he wanted to see. So I gave it my all.

After a knock on the door, the next student entered with a brief introduction and a shake of the hand. I squeezed his hand as hard as I could, squeezed his hand and fell back on the table, mouth agape and eyes open.

This last student impressed me with his quick reaction but he also gave me a start. He immediately began locating my sternum with his fingers and I wondered if I was going to leave this room with a broken rib. Somewhat the thespian himself he turned his back to the camera and started to perform mock compressions on me. Nothing strong enough to hurt me, but I guess he wanted the people watching to know he knew how to perform CPR.

I broke the first rule of theater and dropped character. I don't think it mattered at that point, but I cracked a smile and told him he could leave.

With a solemn look on his face and disappointment in his voice he slouched over the sink and said, "I killed my first patient." This guy was good.

I saw eight students in all that day, all of whom I gave average to high marks. I counted off for things like not pulling out the footrest when laying me back on the table or repeatedly wanting to sit me back up when I kept complaining of dizziness. I awarded higher marks for things like maintaining eye contact and just providing that comforting touch. Whether they asked the right questions or used their instruments correctly I don't know. Judging that's up to the real doctors. Not me.

I got a call this morning from the school wanting to know if I could come back next Wednesday and do it again. I can't wait to see what sort of scenario I get handed. Will I get to be a psychopathic self-mutilator? A plane crash victim? Or just some lousy flu sufferer?

If it's just a flu sufferer I'm gonna have to come up with a little something more interesting to watch. Maybe in the middle of the exam I turn my head around and screech Your mother sews socks that smell!

Yeh, that would be good.

At least they want me to come back.

They like me, Mother. They really really like me.

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